Top

European Journal of Trauma and Emergency Surgery

Published in:

01-12-2013 | Original Article

Clinical outcomes of multiple rib fractures: does age matter?

Authors: H. Abdulrahman, I. Afifi, A. El-Menyar, A. Al-Hassani, A. Almadani, H. Al-Thani, R. Latifi

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2013

Abstract

Purpose

To evaluate the clinical outcomes of multiple rib fracture due to blunt trauma in young patients, a 3-year retrospective study was conducted. Patients with ≥3 rib fractures were divided into two groups (group I: <45 years old and group II: ≥45 years old). Mortality, hospital stay, ventilatory support, chest tubes insertion and associated injuries were studied.

Results

Of the 902 patients admitted with blunt chest trauma, 240 (27 %) met the inclusion criteria and 72.5 % patients were <45 years old. The most common causes of injury were motor vehicle crash (59 %) and fall (29 %). The Injury Severity Score (ISS) was higher in group I (16 ± 9 vs. 13 ± 6; p = 0.04). Hospital mortality was higher in group II (6 vs. 2 %; p = 0.18). Pneumothorax, haemothorax and ventilatory support were comparable. Patients in group II were more likely to undergo chest tubes insertion (26 vs. 14 %; p = 0.04), while group I had a significantly higher incidence of associated abdominal injuries (25 vs. 12 %; p = 0.03).

Conclusion

Old age presenting with rib fractures is associated with higher mortality in comparison to young age; however, this difference becomes statistically insignificant in the presence of multiple rib fracture.

Ziegler DW, Agarwal NN. The morbidity and mortality of rib fractures. J Trauma. 1994;37:975–9.PubMedCrossRef

Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48:1040–6.PubMedCrossRef

Bergeron E, Lavoie A, Clas D, et al. Elderly trauma patients with rib fractures are at greater risk of death and pneumonia. J Trauma. 2003;54(3):478–85.PubMedCrossRef

Al-Hassani A, Abdulrahman H, Afifi I, et al. Rib fracture patterns predict thoracic chest wall and abdominal solid organ injury. Am Surg. 2010;76(8):888–91.PubMed

Shorr RM, Rodriguez A, Indeck MC, et al. Blunt chest trauma in the elderly. J Trauma. 1989;29(2):234–7.

Shweiki E, Klena J, Wood GC, Indeck M. Assessing the true risk of abdominal solid organ injury in hospitalized rib fracture patients. J Trauma. 2001;50(4):684–8.PubMedCrossRef

Lee RB, Bass SM, Morris JA Jr, MacKenzie EJ. Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. J Trauma. 1990;30(6):689–94.PubMedCrossRef

Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery. 2005;138(4):717–23; discussion 723–5.PubMedCrossRef

Maull KI. Age and adverse outcomes in rib fracture patients. South Med J. 2006;99:333.PubMedCrossRef

10.

Demetriades D, Sava J, Alo K, et al. Old age as a criterion for trauma team activation. J Trauma. 2001;51(4):754–6; discussion 756–7.PubMedCrossRef

11.

Kuhne CA, Ruchholtz S, Kaiser GM, et al. Mortality in severely injured elderly trauma patients—when does age become a risk factor? World J Surg. 2005;29:1476–82.PubMedCrossRef

12.

Testerman GM. Adverse outcomes in younger rib fracture patients. South Med J. 2006;99(4):335–9.PubMedCrossRef

13.

Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA. Morbidity from rib fractures increases after age 45. J Am Coll Surg. 2003;196(4):549–55.PubMedCrossRef

14.

Livingston DH, Shogan B, John P, Lavery RF. CT diagnosis of rib fractures and the prediction of acute respiratory failure. J Trauma. 2008;64(4):905–11.PubMedCrossRef

15.

Sochor MR, Webber P, Bednarski B, Wang SC. 3D CT imaging versus plain X-ray in diagnosis of rib fractures in lateral impact crashes. Annu Proc Assoc Adv Automot Med. 2003;47:617–8.

16.

NationaMaster.com. Age distribution in Qatar. http://www.nationmaster.com/country/qa-qatar/Age-_distribution. Accessed 20 Sept 2012.

17.

Sirmali M, Türüt H, Topçu S, et al. A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. Eur J Cardiothorac Surg. 2003;24(1):133–8.PubMedCrossRef

18.

Wu CL, Jani ND, Perkins FM, Barquist E. Thoracic epidural analgesia versus intravenous patient-controlled analgesia for the treatment of rib fracture pain after motor vehicle crash. Trauma. 1999;47:564–7.CrossRef

19.

Easter A. Management of patients with multiple rib fractures. Am J Crit Care. 2001;10:320–7.PubMed

20.

Richardson JD. Indications for thoracotomy in thoracic trauma. Curr Surg. 1985;42:361–4.PubMed

21.

Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur J Cardiothorac Surg. 2003;23(3):374–8.PubMedCrossRef

Title: Clinical outcomes of multiple rib fractures: does age matter?
Authors: H. Abdulrahman
I. Afifi
A. El-Menyar
A. Al-Hassani
A. Almadani
H. Al-Thani
R. Latifi
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2013
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-013-0291-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Clinical outcomes of multiple rib fractures: does age matter?

Abstract

Purpose

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2013

Diagnosis of cervical spine injuries in children: a systematic review

Is computed tomography necessary to determine liver injury in pediatric trauma patients with negative ultrasonography?

Deep venous thrombosis following different isolated lower extremity fractures: what is known about prevalences, locations, risk factors and prophylaxis?

Series on vascular injuries. Part III: complex injuries and difficult problems

Vascular complications and special problems in vascular trauma

Are soft tissue measurements on lateral cervical spine X-rays reliable in the assessment of traumatic injuries?